Mini mental state

Question 1

main principles

Answer 1

• gain consent
• start with open questions
• conclude early if too distressing
  -respond to distress with empathy
• be curious
• ## report back findings to clinician in charge

Question 2

general psychiatric assessment flow/

Answer 2

Introduction
History of Presenting Complaint
Past Psychiatric History
Family History
Personal History
Past Medical History
Use of Medication / Drugs / Alcohol
Forensic History
Mental State Examination
Relevant Physical Examination
Risk Assessment

Question 3

history of presenting complaint q examples

Answer 3

What is the problem?
How long has it been like this?
What was happening when this started?
What make things worse? Or better?
NB May be difficult to identify starting point – Start of problems? Presentation to GP? Admission to ward?
Choose what seems relevant at the time

Question 4

PAST PSYCHIATRIC HISTORY QS

Answer 4

“Have you ever had anything like this before?”
“Did you ever seek help for this in the past?”
“Have you ever been in hospital for this before”
“What treatments have you tried in the past?”

Question 5

personal history qs

Answer 5

Birth
Early development
School - social / academic
Home environment
Qualifications
Relationships and children
Work

Question 6

PMH qs

Answer 6

Medical Conditions
Admissions
Surgical Procedures
Head Injuries ?Accidents
Deliberate Self Harm

Question 7

Medication, drugs and alcohol qs

Answer 7

Current Medication
Allergies
Illicit Drug use
How much?
What?
Alcohol Consumption
How much and how often?
How long?

Question 8

questions to clarify alcohol and drug use

Answer 8

So what do you actually mean by social drinking?”
“Do you drink every day?”
“What age were you when you first started using drugs?”
“Have you ever injected? Which veins do you use?”

Question 9

forensic history qs?

Answer 9

juvenile crime
court appearances
convictions
length of sentence
against person / property
experience of prison

Question 10

what is the MSE

Answer 10

• Paints picture of what the patient is like at the time of assessment.

-Allows the doctor to make an accurate diagnosis and formulation.

Question 11

main points of the MSE

Answer 11

Appearance and behaviour
Speech
Mood
Thoughts
Perceptions
Cognition
Insight

Question 12

What to see in appearance

Answer 12

Appearance:
Build, dress
Hygiene
Evidence of self neglect
Evidence of self harm
Weight
Objects

Question 13

What to see in behavior

Answer 13

Engagement, eye contact, tearfulness anxious
Are they socially appropriate or disinhibited
Are they agitated or distracted
Abnormal movements e.g. tremor

Question 14

modifications for psychiatric exam/

Question 15

important risks to consider

Answer 15

Self neglect
Harm to self
Suicide
Harm to others
Vulnerability to exploitation
Child risk

Question 16

risk assesment?

Answer 16

How likely is it that an event will occur?
When is it expected to occur?
How bad will it be?
Aim is to develop a collaborative plan to reduce the risk and keep the plan under review

Question 17

modifications for psychiatric exam?

Answer 17

Patient distressed
Patient has reduced cognitive/intellectual capacity
Non native speaker
Identification of urgent issues (medical/safeguarding/children)
Concerns about risk/safety issues

Question 17

risk assesment?

Answer 17

How likely is it that an event will occur?
When is it expected to occur?
How bad will it be?
Aim is to develop a collaborative plan to reduce the risk and keep the plan under review

Question 18

important risks to consider

Answer 18

Self neglect
Harm to self
Suicide
Harm to others
Vulnerability to exploitation
Child risk

Question 19

important risks to consider

Answer 19

Self neglect
Harm to self
Suicide
Harm to others
Vulnerability to exploitation
Child risk

Question 19

risk assesment?

Answer 19

How likely is it that an event will occur?
When is it expected to occur?
How bad will it be?
Aim is to develop a collaborative plan to reduce the risk and keep the plan under review

Question 19

modifications for psychiatric exam?

Answer 19

Patient distressed
Patient has reduced cognitive/intellectual capacity
Non native speaker
Identification of urgent issues (medical/safeguarding/children)
Concerns about risk/safety issues

Question 20

what can poor eye contact deduce

Answer 20

auditory hallucinations

Question 21

Speech?

Answer 21

This is the production of speech rather than the content (under thoughts).
Rate e.g. rapid/ pressured (mania)
Rhythm and Tone e.g. monotonous (depression)
Volume e.g. loud, normal, soft
Mutism
neurological/organic signs

Question 22

risk assesment?

Answer 22

How likely is it that an event will occur?
When is it expected to occur?
How bad will it be?
Aim is to develop a collaborative plan to reduce the risk and keep the plan under review

Question 23

modifications for psychiatric exam?

Answer 23

Patient distressed
Patient has reduced cognitive/intellectual capacity
Non native speaker
Identification of urgent issues (medical/safeguarding/children)
Concerns about risk/safety issues

Question 24

important risks to consider

Answer 24

Self neglect
Harm to self
Suicide
Harm to others
Vulnerability to exploitation
Child risk

Question 24

Mood?

Answer 24

Mood -refers to emotion over a prolonged period of time.
subjective – patient’s view of their mood
objective – your assessment
euthymic
depressed or elated
irritable
Anxious
Affect - refers to immediate emotion
reactive
flat or blunted
incongruent

Question 25

important risks to consider

Answer 25

Self neglect
Harm to self
Suicide
Harm to others
Vulnerability to exploitation
Child risk

Question 26

Mood?

Answer 26

Mood -refers to emotion over a prolonged period of time.
subjective – patient’s view of their mood
objective – your assessment
euthymic
depressed or elated
irritable
Anxious
Affect - refers to immediate emotion
reactive
flat or blunted
incongruent

Question 27

modifications for psychiatric exam?

Answer 27

Patient distressed
Patient has reduced cognitive/intellectual capacity
Non native speaker
Identification of urgent issues (medical/safeguarding/children)
Concerns about risk/safety issues

Question 27

risk assesment?

Answer 27

How likely is it that an event will occur?
When is it expected to occur?
How bad will it be?
Aim is to develop a collaborative plan to reduce the risk and keep the plan under review

Question 28

what are thougthts split into

Answer 28

-way thoughts linked together
- stream and form
-content of the thoughts themselves

Question 29

what is stream in relation to thoughtsw

Answer 29

Stream - the amount and speed of thought

Pressure: unusually rapid, abundant and varied.
Poverty: unusually slow, few and unvaried.
Thought blocking: the mind is suddenly empty of thoughts. Can occur in paranoid Schizophrenia.

Question 30

what is form

Answer 30

how well thoughts are linked

Question 31

thought content ?

Answer 31

Delusions
Overvalued ideas
Obsessions
Thoughts of suicide/nihilistic thoughts
Thoughts of harm to others

Question 32

define delusion

Answer 32

A false, unshakeable idea or belief that is firmly held despite evidence to the contrary that is not consistent with the person’s educational, cultural and social background.

Question 33

types of delusions

Answer 33

-persecutory
-delusions of reference
-grandiose
- guilt or wortlessness
- delusions of contrtol

Question 34

Thoughts of self harm or suicide

Answer 34

Thoughts of wishing to be dead
Fleeting suicidal thoughts
Thoughts without plans
Thoughts with plans
If plans what are they
What steps have been taken/planned

Question 35

define illusion

Answer 35

Thoughts of wishing to be dead
Fleeting suicidal thoughts
Thoughts without plans
Thoughts with plans
If plans what are they
What steps have been taken/planned

Question 36

define hallucinations

Answer 36

perception without an external stimulus

Question 37

types of hallucinations

Answer 37

2nd person auditory hallucinations – voices talk to the patient
3rd person auditory hallucinations – voices talking about the patient.
Command hallucinations - voices telling the person to do something

Question 38

define derealisation

Answer 38

feeling the world is not real

Question 39

depersonalisation?

Answer 39

feeling detached from yourself and emotions

Question 40

cognition?

Answer 40

This refers to a person’s current capacity to process information.
Comment on
Level of consciousness
Orientation to time and place
Ability to engage with the assessment and take on new information.

Question 41

what is insight

Answer 41

The patient’s awareness and understanding of their mental illness, it takes into account –